Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists. A place to talk; no one has to listen.
All patient vignettes are confabulated; the psychiatrists, however, are mostly real.
--Topics include psychotherapy, humor, depression, bipolar, anxiety, schizophrenia, medications, ethics, psychopharmacology, forensic and correctional psychiatry, psychology, mental health, chocolate, and emotional support ducks. Don't ask. (It's not Shrink Wrap.)

Tuesday, January 29, 2013

Oh, Clink is going to hate me for that provocative post title, but so it goes. There's so much going on that I'm going to put up a few posts in a row.

This one is to ask for your feedback: How are people in New York feeling about the new law requiring therapists to report people they feel are likely to be dangerous? Read my viewsHereand Clink's viewHere. I'm watching legislation in Maryland carefully. So far, our governor has proposed legislation that requires reporting all patients who have a continuous stay in a psychiatric facility for over 30 days, voluntary or not. I figure this probably captures eating disordered patients, geriatric admissions, and forensic patients (--who mostly already get reported because the current law requires reporting involuntary patients in state hospitals for over 30 days). You can later request your gun rights back by appealing with a letter from a psychiatrist certifying that you are safe. I'll get you a list of psychiatrists who will be providing those, right along side those who will be prescribing medical marijuana, which is also back in the hopper again.

We are expecting a bill to be proposed soon that will require therapists to report dangerous patients -- hopefully it will go nowhere. Oddly enough, while there is legislation mandating that psych patients be reported to the government to curtail their access to guns, there is also legislation proposed by Delegate Don Dwyer proposing that ammunition sales people may not require identification in order to purchase ammunition and forbidding such information to be given to the government. I may move to Delegate Dwyer's district just so I can vote against him. The last time I had a cold, I was required to fill out forms and provide my drivers' license (taken to the back room for several minutes) before I could get a single box of decongestants. I look like the Meth Lab type? (Oh, but I am enjoying Breaking Bad).

The baltimore sun's article at today's site about Maryland legislation/commission for review after the Newtown shooting that was the template for the NY law is DISTURBING to read. How disingenuous is our Governor, to tell the public he wants to improve mental health services and protect the public, when his history with the State is fairly much the opposite, and now he wants to make us defacto cops?

The sad part to this process, is how many psychiatrists will just go through the motions and agree to this role if such legislation passes. How many people who work as mental health care providers actually consider advocacy as part of the job? Dwindling number is a nice way to label it!

So much of this is just a politician going through the motion of acting on a popular cause, knowing that the proposal will never pass. The problem is that it takes so much darn time and energy to explain to the general public (and legislature) why something like this is a bad idea.

I just wish they'd start with a good idea to begin with so we'd have something to work with.

That's the Baltimore Sun? SMH. What a sad example of a piece of writing.

Here's the key sentence that demonstrates the depth of confusion on this issue:

"That debate hinges on the responsibility of doctors, addiction counselors and other mental health professionals to maintain patient confidentiality — and to protect public safety, to the extent that they can"

Have we accepted the premise that physicians (among others) are agents of the State to the extent that it is our "responsibility" to protect public safety?

So, the Baltimore Sun believes we are already agents of the State. Are we?

I live in NY. I asked my psychiatrist about this recently and she stated that she feels very comfortable not reporting suicidal patients and does not intend to. She pointed out that currently it isn't even clear to whom one reports to and that it's clear that there will be no sanctions for not reporting patients. She also said that her malpractice insurance is currently advising a wait and see approach.

That said, I also don't own a gun and am not interested in buying one.

Also going through the tutorials, am I correct to code for a e/m 99214 solely based on time when I see med management patients for 30 minutes of which greater than 50% of the time was spent in coordination of care and counseling?

After years of passing anti-gun bills in the Assembly, the anti-gun Democrats from NY City finally took control of the NY Senate and are able to pass any bill that they want. It is amazing to us that after passing anti-gun bills in the NY Assembly for decades, that they did such a horrible job in writing this bill. We all wonder that if we go to any Dr. and they ask about guns and we say that we support the 2nd Amendment and the bills that they passed infringe on our constitutional rights, will that be enough to put us on the "NO GUN" list? George OCShooters.com